Abstract 1713: Does Body Composition Impact Survival in Patients with Advanced Heart Failure
Although obesity is a potent risk factor for cardiovascular diseases, including heart failure (HF), numerous studies have indicated an “obesity paradox,” since obese patients with HF often have a better prognosis compared with lean HF patients. We previously reported this paradox regarding body composition, with higher % body fat (BF) and higher body mass index (BMI) predicting a lower rate of cardiac death and urgent transplantation in a relatively small HF population. We sought to determine the impact of body composition, including % BF determined by the sum of the skin fold method (utilizing the average of 3 skin folds - thigh, chest and abdomen in men; thigh, triceps and suprailium in women) and BMI, on all-cause mortality in 875 patients with advanced HF (age 56±13 years; 71% male; EF 24±9%; BMI 29.0±5.5 kg/m2; % BF 28.8±8.6%) followed 3.0±1.8 years. Compared with the 757 survivors, the 118 patients who died had higher baseline age (p<0.0001), %male (p=0.01), BNP (p=0.01) and lower LVEF (p=0.01), creatinine clearance (p=0.01), and peak exercise oxygen consumption (p<0.0001).Both groups were statistically similar regarding plasma sodium and blood hemoglobin concentrations. Baseline % BF trended higher in survivors (29.0 ± 8.6 vs 27.6 ± 8.4%; p=0.1), but both survivors and those who died had statistically similar BMI (29.1 ± 5.5 vs 28.9 ± 4.0 kg/m2; p=0.34). In multivariate analysis, however, utilizing 8 independent variables, both obesity indices (entered individually, including higher % BF - t-value 2.4, p=0.02; and BMI - t-value 2.2, p=0.03) were second only to BNP (t-value 3.2; p<0.01) as independent predictors of better time-dependent survival.
CONCLUSIONS: These results support the potential protective effects of obesity, particularly higher % BF, on survival in mostly overweight and obese patients with advanced HF. Further studies are needed to elucidate the mechanisms of this “paradox”, as well as to determine whether this effect is present in HF populations with lower prevalence of overweightness and obesity.